Coronary intervention for persistent occlusion after myocardial infarction.

Background: It is unclear whether stable, high-risk patients with persistent total occlusion of the infarct-related coronary artery identified after the currently accepted period for myocardial salvage has passed should undergo percutaneous coronary intervention (PCI) in addition to receiving optimal medical therapy to reduce the risk of subsequent events.

Methods: We conducted a randomized study involving 2166 stable patients who had total occlusion of the infarct-related artery 3 to 28 days after myocardial infarction and who met a high-risk criterion (an ejection fraction of <50% or proximal occlusion). Of these patients, 1082 were assigned to routine PCI and stenting with optimal medical therapy, and 1084 were assigned to optimal medical therapy alone.

Role of amiodarone or implantable cardioverter/defibrillator in patients with atrial fibrillation and heart failure.

Background: Heart failure complicated by atrial fibrillation (AF) is associated with excessive mortality and morbidity. The aim of the study was to determine the role of amiodarone or implantable cardioverter/defibrillator (ICD) in patients with AF and heart failure.

Methods: Patients were determined to be in sinus rhythm (SR) or AF on the baseline electrocardiogram.

The high cost of implantable defibrillators.

Increased use of ICDs in patients with cardiac disease has the potential to strain national health care budgets because of the large numbers of eligible patients and the high cost of the ICDs. Randomized trials show ICDs increase life-expectancy in some groups of patients and also increase total medical costs significantly. ICDs exemplify the role of new technology as the main force behind rising health care costs.

Mastery, perceived stress and health-related behaviour in northeast Arnhem Land: a cross-sectional study.

Background: Indigenous peoples in Australia are disadvantaged on all markers of health and social status across the life course. Psychosocial factors are implicated in the aetiology of chronic diseases and in pathways underpinning social health disparities. Minimal research has investigated psychosocial factors and health in Indigenous peoples.

Natriuretic peptides in the diagnosis and management of heart failure.

The natriuretic peptides are a family of related hormones that play a crucial role in cardiovascular homeostasis. They have recently emerged as potentially important clinical markers in heart failure. Recent data have suggested an important role for these markers in establishing the diagnosis of heart failure in patients with unexplained dyspnea in both acute care and ambulatory settings.

Central nervous system injury associated with cardiac surgery.

Millions of individuals with coronary artery or valvular heart disease have been given a new chance at life by heart surgery, but the potential for neurological injury is an Achilles heel. Technological advancements and innovations in surgical and anaesthetic technique have allowed us to offer surgical treatment to patients at the extremes of age and infirmity-the group at greatest risk for neurological injury. Neurocognitive dysfunction is a complication of cardiac surgery that can restrict the improved quality of life that patients usually experience after heart surgery.

Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT).

Background: In the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), implantable cardioverter-defibrillator (ICD) therapy significantly reduced all-cause mortality rates compared with medical therapy alone in patients with stable, moderately symptomatic heart failure, whereas amiodarone had no benefit on mortality rates. We examined long-term economic implications of these results.

Methods And Results: Medical costs were estimated by using hospital billing data and the Medicare Fee Schedule.

High rates of HIV testing despite low perceived HIV risk among African-American sexually transmitted disease patients.

Purpose: In the current diagnosis-based, human immunodeficiency virus (HIV) prevention climate, previous testing among persons at elevated HIV risk has cost and efficacy implications, as it signals continued behavioral risk, limited HIV knowledge or overuse of services. This study sought to determine the proportion of African Americans newly seeking sexually transmitted disease (STD) diagnosis who previously had obtained HIV counseling and testing.

Methods: This was a clinic-based, cross-sectional survey of African-American adults (N=408) seeking STO diagnosis at a public STD clinic located in a high-HIV and STD prevalence city in the U.

What is the economic value of digoxin therapy in congestive heart failure patients? Results from the DIG trial.

Background: The Digitalis Investigation Group (DIG) clinical train randomized 6800 congestive heart failure patients (ejection fraction > or =45%) to a daily regimen of either digoxin or placebo. At 37 months average follow-up, patients in both groups had similar mortality. We determined the incremental costs associated with the use of digoxin in this high-risk population.

Association of neurocognitive function and quality of life 1 year after coronary artery bypass graft (CABG) surgery.

Objective: Although coronary artery bypass grafting (CABG) has been shown to improve quality of life and functional capacity for many patients, recent studies have demonstrated that a significant number of patients exhibit impairment in cognitive function immediately following surgery and beyond. We sought to determine the impact of this postoperative cognitive dysfunction on quality of life (QOL) and to characterize the dysfunction from the patient's perspective.

Methods: With Institutional Review Board (IRB) approval and written informed consent, 732 patients at Duke University Hospital undergoing CABG were enrolled.

Aboriginal status is a prognostic factor for mortality among antiretroviral naïve HIV-positive individuals first initiating HAART.

Background: Although the impact of Aboriginal status on HIV incidence, HIV disease progression, and access to treatment has been investigated previously, little is known about the relationship between Aboriginal ethnicity and outcomes associated with highly active antiretroviral therapy (HAART). We undertook the present analysis to determine if Aboriginal and non-Aboriginal persons respond differently to HAART by measuring HIV plasma viral load response, CD4 cell response and time to all-cause mortality.

Methods: A population-based analysis of a cohort of antiretroviral therapy naïve HIV-positive Aboriginal men and women 18 years or older in British Columbia, Canada.

Test agreement for classifying diabetes in indigenous Australians.

Objective: To evaluate for Indigenous Australians the agreement between a fasting plasma glucose (FPG) criterion of 7.0 mmol/L and diabetes test results using a two-hour oral glucose tolerance test (OGTT), comparing relationships between test agreement and prevalence to similar studies.

Methods: Screening was undertaken in 25 remote settlements.

Associations among education, cortisol rhythm, and BMI in blue-collar women.

Objective: This study sought to test whether a biological measure of chronic stress, Delta cortisol, was related to BMI and whether the relationship between Delta cortisol and BMI varied according to education and positive affect.

Research Methods And Procedures: One hundred fifty-four women from a blue-collar women's health project in 11 industrial sites in rural North Carolina provided saliva for cortisol assays for a substudy on "stress." Delta Cortisol, the difference between awakening and midday cortisol measures representing diurnal decline, was calculated (lower values = greater stress).

Satellite-cell pool size does matter: defining the myogenic potency of aging skeletal muscle.

The deteriorating in vivo environment is thought to play a major role in reduced stem cell function with age. The capacity of stem cells to support tissue maintenance depends not only on their response to cues from the surrounding niche, but also on their abundance. Here, we investigate satellite cell (myogenic stem cell) pool size and its potential to participate in muscle maintenance through old age.

The value of estimated functional capacity in estimating outcome: results from the NHBLI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study.

Objectives: Our objective was to determine the prognostic value of estimated metabolic equivalents (METs) based on self-reported functional capacity by the Duke Activity Status Index (DASI) in symptomatic women.

Background: Functional capacity is an important component affecting the predictive value of exercise testing, yet current guidelines offer limited assistance regarding identification of functional impairment and choice of pharmacologic stress testing.

Methods: A total of 914 women underwent clinically indicated coronary angiography and completed the 12-item DASI questionnaire; a subgroup of 251 women also underwent exercise testing.

Costs for heart failure with normal vs reduced ejection fraction.

Background: Among the elderly population, heart failure (HF) with normal ejection fraction (EF) is more common than classic HF with low EF. However, there are few data regarding the costs of HF with normal EF. In a prospective, population-based cohort of elderly participants, we compared the costs and resource use of patients with HF and normal and reduced EF.

Cardiac resynchronization therapy: Part 2--issues during and after device implantation and unresolved questions.

Encouraged by the clinical success of cardiac resynchronization therapy (CRT), the implantation rate has increased exponentially, although several limitations and unresolved issues of CRT have been identified. This review concerns issues that are encountered during implantation of CRT devices, including the role of electroanatomical mapping, whether CRT implantation should be accompanied by simultaneous atrioventricular nodal ablation in patients with atrial fibrillation, procedural complications, and when to consider surgical left ventricular lead positioning. Furthermore, (echocardiographic) CRT optimization and assessment of CRT benefits after implantation are highlighted.

Cardiac resynchronization therapy: Part 1--issues before device implantation.

Cardiac resynchronization therapy (CRT) has been used extensively over the last years in the therapeutic management of patients with end-stage heart failure. Data from 4,017 patients have been published in eight large, randomized trials on CRT. Improvement in clinical end points (symptoms, exercise capacity, quality of life) and echocardiographic end points (systolic function, left ventricular size, mitral regurgitation) have been reported after CRT, with a reduction in hospitalizations for decompensated heart failure and an improvement in survival.

A new anatomic score for prognosis after cardiac catheterization in patients with previous bypass surgery.

Objectives: The purpose of this study was to determine the value of a new anatomic score for prognosis after diagnostic catheterization in patients with previous coronary artery bypass grafting (CABG).

Background: Previous CABG patients comprise a growing proportion of patients with coronary artery disease (CAD). Whereas prognostic scores are available to adjust for native CAD, there are no comparable scores for patients with previous CABG.

Design and methodology of the Occluded Artery Trial (OAT).

Experimental and clinical studies have suggested that late opening of an infarct-related artery (IRA) after myocardial infarction (MI) could improve clinical outcome. However, the suggestive observational data are limited by selection biases. Indeed, most small randomized studies have not demonstrated benefit.

Music, imagery, touch, and prayer as adjuncts to interventional cardiac care: the Monitoring and Actualisation of Noetic Trainings (MANTRA) II randomised study.

Background: Data from a pilot study suggested that noetic therapies-healing practices that are not mediated by tangible elements-can reduce preprocedural distress and might affect outcomes in patients undergoing percutaneous coronary intervention. We undertook a multicentre, prospective trial of two such practices: intercessory prayer and music, imagery, and touch (MIT) therapy.

Methods: 748 patients undergoing percutaneous coronary intervention or elective catheterisation in nine USA centres were assigned in a 2x2 factorial randomisation either off-site prayer by established congregations of various religions or no off-site prayer (double-blinded) and MIT therapy or none (unmasked).

Economic analysis of the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT-3) study: costs of reperfusion strategies in acute myocardial infarction.

Background: The ASSENT-3 study examined the safety and efficacy of 3 alternative regimens for ST-elevation acute myocardial infarction: full-dose tenecteplase (TNK-tPA) plus enoxaparin; half-dose TNK-tPA plus unfractionated heparin plus abciximab; and full-dose TNK-tPA plus unfractionated heparin.

Objective: The aim of the study was to examine the resource and economic effects of the 3 regimens in ASSENT-3 using empirically collected data from the trial.

Methods: Cost estimates for each resource use component collected in ASSENT-3 were derived from Medicare reimbursement rates and from detailed billing data collected as part of a previous study.

Hostility, age, and mortality in a sample of cardiac patients.

This study examined hostility as a predictor of survival in a sample of 1,328 patients who had documented coronary artery disease. After controlling for disease severity, there was a significant interaction between age and hostility. Hostility was significantly associated with poorer survival but only in younger (<61.